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Kirshenbaum JS, Pagliaccio D, Bitran A, Xu E, Auerbach RP. Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review. Transl Psychiatry 2024; 14:266. [PMID: 38937430 PMCID: PMC11211511 DOI: 10.1038/s41398-024-02914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.
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Affiliation(s)
- Jaclyn S Kirshenbaum
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Alma Bitran
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Elisa Xu
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
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Chalker SA, Sicotte R, Bornheimer LA, Parrish EM, Wastler H, Ehret B, DeVylder J, Depp CA. A call to action: informing research and practice in suicide prevention among individuals with psychosis. Front Psychiatry 2024; 15:1378600. [PMID: 38711871 PMCID: PMC11073495 DOI: 10.3389/fpsyt.2024.1378600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.
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Affiliation(s)
- Samantha A. Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Roxanne Sicotte
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Lindsay A. Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Emma M. Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Heather Wastler
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Jordan DeVylder
- Silver School of Social Work, New York University, New York, NY, United States
| | - Colin A. Depp
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
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Armstrong G, Haregu T, Cho E, Jorm AF, Batterham P, Spittal MJ. Transition to a first suicide attempt among young and middle-aged males with a history of suicidal thoughts: A two-year cohort study. Psychiatry Res 2023; 328:115445. [PMID: 37666006 DOI: 10.1016/j.psychres.2023.115445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Although many studies have examined the risk and protective factors associated with suicidal behavior, little is known about the probability of transition from suicidal thoughts to suicidal attempts and the factors that distinguish those who have suicidal thoughts from those who progress to a suicide attempt. OBJECTIVES To determine the probability and predictors of transition to a suicide attempt among young and middle-aged males with a history of suicidal thoughts but no prior history of attempting suicide. METHODS We used data from the first two waves of the Australian Longitudinal Study on Male Health, approximately two years apart. We followed the cohort of males aged 18-55 years who, at wave 1, reported a lifetime history of suicidal ideation but no history of a prior suicide attempt. We report transition probabilities to a first suicide attempt at Wave 2 and used logistic regression models to examine baseline predictors of transition to a first suicide attempt over the two-year period among males aged 18 years and older. RESULTS From the 1,564 males with suicidal thoughts at wave 1,140 participants (8.9%; 95% CI:7.6,10.5) reported to have had their first suicide attempt in the two-year period. In multivariate analyses, males aged 30-39 (OR=0.31; 95% CI: 0.16,0.60), 40-49 (OR=0.47; 95% CI:0.24,0.91) and 50-55 (OR=0.31; 95% CI: 0.13,0.73) all had lower odds of a first suicide attempt compared to males aged 18-29 years. The odds of a first suicide attempt were significantly higher for males who were: living in inner regional areas (ref: major cities) (OR=2.32; 95% CI: 1.33,4.04); homosexual or bisexual (OR=2.51; 95% CI: 1.17,5.36); working night shift as their main job (OR=1.75; 95% CI: 1.05,2.91); and, living with a disability (OR=1.99; 95% CI: 1.07,3.65). Clinical indicators such as symptoms of depression and illicit substance use were not significant predictors of transition to a first suicide attempt in multivariate models, nor were indicators of social connection. CONCLUSION We estimated that 8.9% of Australian males aged 15-55 years with a history of suicidal thoughts and no prior history of suicide attempts will progress to a first suicide attempt within two-years. Neither psychological distress, illicit substance use nor social connection indicators were correlated with transition to a first suicide attempt. Rather, it was socio-demographic indicators that were associated with transition to a first suicide attempt.
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Affiliation(s)
- G Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - T Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - E Cho
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - A F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Batterham
- National Centre for Epidemiology and Population Health, Canberra, Australia
| | - M J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Luo X, Yu T, Yang Z, Wang D. Psychotic-Like Experiences and Suicidal Ideation Among Adolescents: The Chain Mediating Role of Insomnia Symptoms and Resilience. Psychol Res Behav Manag 2023; 16:3519-3530. [PMID: 37675191 PMCID: PMC10478937 DOI: 10.2147/prbm.s426363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023] Open
Abstract
Background Individuals who experience psychotic-like experiences (PLEs) are at significant risk of suicide-related behaviors. This two-wave longitudinal study aimed to investigate the relationships among PLEs, insomnia symptoms, resilience, and suicidal ideation (SI) among adolescents. Methods A total of 2231 college students [mean age (standard deviation) = 20.02 (1.39) years] completed two web-based surveys. Participants completed self-report measures of sample characteristics, PLEs, insomnia symptoms, resilience, and SI. Results The findings indicated a significantly positive correlation between PLEs and SI that was sequentially mediated by insomnia symptoms and resilience. Furthermore, insomnia symptoms and resilience played a chain-mediating role between PLEs and adolescent SI. Conclusion These findings suggest potential mechanism for the PLEs-SI link, which helps us better understand how PLEs can influence individual SI and provides important information for early prevention.
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Affiliation(s)
- Xi Luo
- School of Educational Science, Hunan Normal University, Changsha, Hunan Province, People’s Republic of China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, Hunan Province, People’s Republic of China
- Hunan First Normal University, Changsha, Hunan Province, People’s Republic of China
| | - Taowen Yu
- Department of Applied Psychology, Changsha Normal University, Changsha, Hunan Province, People’s Republic of China
| | - Zilu Yang
- College of Education, Hunan Agricultural University, Changsha, Hunan Province, People’s Republic of China
| | - Dongfang Wang
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, Centre for Studies of Psychological Applications, School of Psychology, South China Normal University, Guangzhou, Guangdong Province, People’s Republic of China
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Steenkamp LR, de Neve-Enthoven NGM, João AM, Bouter DC, Hillegers MHJ, Hoogendijk WJG, Blanken LME, Kushner SA, Tiemeier H, Grootendorst-van Mil NH, Bolhuis K. Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts. Schizophr Res 2023; 257:50-57. [PMID: 37285715 DOI: 10.1016/j.schres.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/10/2023] [Accepted: 05/06/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prior studies have shown that psychotic experiences are prospectively associated with an increased risk of suicidality. However, it is unclear whether this association is causal or arises from shared risk factors. Furthermore, little is known about the association between psychotic experiences and non-suicidal self-injury (NSSI). METHODS We used data from two independent samples of young adolescents, which we analyzed separately. In a population-based cohort, data on hallucinatory experiences and suicidality were collected at ages 10 and 14 years (N = 3435). In a cross-sectional study of a population oversampled for elevated psychopathology levels, psychotic experiences, suicidality, and NSSI were assessed at age 15 years (N = 910). Analyses were adjusted for sociodemographic covariates, maternal psychopathology, intelligence, childhood adversity, and mental health problems. RESULTS Psychotic experiences were prospectively associated with an increased risk of suicidality, even when considering self-harm ideation at baseline. Furthermore, persistent and incident, but not remittent, patterns of psychotic experiences were related to an increased burden of suicidality. Self-harm ideation was also prospectively associated with the risk for psychotic experiences, although of smaller magnitude and only by self-report. Among at-risk adolescents, psychotic experiences were cross-sectionally associated with a greater burden of suicidality and a higher frequency of NSSI events, with more extensive tissue damage. CONCLUSION Psychotic experiences are longitudinally associated with suicidality beyond the effects of shared risk factors. We also found modest support for reverse temporality, which warrants further investigation. Overall, our findings highlight the importance of assessing psychotic experiences as an index of risk for suicidality and NSSI.
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Affiliation(s)
- Lisa R Steenkamp
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Amanda Moreira João
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Diandra C Bouter
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Laura M E Blanken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Steven A Kushner
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, USA
| | | | - Koen Bolhuis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
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Jay SY, DeVylder J, Schiffman J, Pitts SC, Marsh J, Zhou S, Oh H. Exploring the relation between psychosis-like experiences and suicidal ideation, plans, and attempts among college students in the United States. Early Interv Psychiatry 2023; 17:272-280. [PMID: 35712796 DOI: 10.1111/eip.13325] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/27/2022] [Accepted: 05/29/2022] [Indexed: 11/25/2022]
Abstract
AIM The suicide rate among college students is particularly high, with evidence that psychosis-like experiences (PLEs) put these individuals at greater risk. The current study explored whether there are differential relations between four subtypes of PLEs and three suicide outcomes. METHODS We analysed a large sample of college students from the Fall semester cohort of the 2020 Healthy Minds Study (HMS) (weighted N = 36727). PLEs and suicide outcomes were assessed using binary variables from the World Health Organization Composite International Diagnostic Interview. RESULTS Findings revealed that reporting any of the subtypes of PLEs was associated with greater odds of suicidal ideation (SI), a suicide plan (SP) and a suicide attempt (SA) (signficant a ORs ranging from 1.30 to 3.30). For college students who endorsed SI or a SP in the past year, experiencing delusional mood (aOR [95% CI] = 1.30 [1.02-1.65]), suspiciousness (aOR [95% CI] = 1.31 [1.00-1.71]) and hallucinatory experiences (aOR [95% CI] = 2.76 [2.05-3.71]) in their lifetime increased their odds of reporting a SA in the past year. There was also evidence of a dose-dependent relation between the number of PLEs endorsed and all three suicide outcomes. CONCLUSIONS Certain subtypes of PLEs including delusional mood, suspiciousness and hallucinatory experiences may contribute to an elevated risk of suicide outcomes in college students. Moreover, the odds of reporting suicide outcomes were greater for individuals who endorsed a greater number of PLEs. It may be helpful to assess for indicated subtypes when determining suicide risk among college students and to be particularly mindful of those who report three or more PLEs.
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Affiliation(s)
- Samantha Y Jay
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Jason Schiffman
- Department of Psychological Science, Social and Behavioral Sciences Gateway, University of California, Irvine, California, USA
| | - Steven C Pitts
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Jonathan Marsh
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Sasha Zhou
- School of Public Health, Wayne State University, Detroit, Michigan, USA
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Irvine, California, USA
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Hielscher E, DeVylder J, Hasking P, Connell M, Martin G, Scott JG. Mediators of the association between psychotic experiences and future non-suicidal self-injury and suicide attempts: results from a three-wave, prospective adolescent cohort study. Eur Child Adolesc Psychiatry 2021; 30:1351-1365. [PMID: 32712716 DOI: 10.1007/s00787-020-01593-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/28/2020] [Indexed: 01/17/2023]
Abstract
Psychotic experiences (PEs) are robustly associated with subsequent non-suicidal self-injury (NSSI) and suicide attempts, but questions remain as to the temporal relation and underlying cause of this association. Most investigations have incorporated only two waves of data, and no study has comprehensively investigated mediating pathways. This study aimed to investigate both the PE-NSSI and PE-suicide attempt association, and their relevant mediators, across three waves of prospective data. Participants were from an Australian prospective longitudinal cohort of 1100 adolescents (12-17 years); data were collected at three time points over 2 years. NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess four PE subtypes (auditory hallucinatory experiences [HEs] and three delusional experiences). Potential mediators of interest included: psychological distress, self-reported mental disorders, self-esteem, recent traumatic life events (e.g. bullying, sexual assault), emotion regulation, and impulsivity/other personality traits. Analyses were adjusted for sociodemographics and substance use. Auditory HEs were indirectly associated with future NSSI and suicide attempts via recent traumatic life events, high psychological distress, and low self-esteem, across three waves of data. Other PE subtypes were generally not associated with incident NSSI/suicide attempts at 1- and 2-year follow-up, either directly or indirectly. These findings highlight the importance of screening for auditory HEs when assessing a young person's self-harm/suicide risk. Clinical assessment would be further enhanced by a comprehensive review of recent interpersonal traumatic events, as well as levels of self-esteem and distress.
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Affiliation(s)
- Emily Hielscher
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia. .,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. .,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - Melissa Connell
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Graham Martin
- Department of Psychiatry, The University of Queensland, Brisbane, QLD, Australia
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD, Australia
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de Cates AN, Catone G, Marwaha S, Bebbington P, Humpston CS, Broome MR. Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey. Schizophr Res 2021; 233:80-88. [PMID: 34246091 PMCID: PMC8388846 DOI: 10.1016/j.schres.2021.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/17/2021] [Accepted: 06/21/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Schizophrenia is associated with premature mortality, partly through increased suicide rates. AIMS To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). METHOD We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. RESULTS In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. CONCLUSIONS Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.
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Affiliation(s)
- Angharad N de Cates
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Gennaro Catone
- Department of Educational, Psychological and Communication Sciences, Suor Orsola Benincasa University, Naples, Italy
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Clara S Humpston
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, UK
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9
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Can't get you out of my head: Persistence and remission of psychotic experiences in adolescents and its association with self-injury and suicide attempts. Schizophr Res 2021; 229:63-72. [PMID: 33248885 DOI: 10.1016/j.schres.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Persistent psychotic experiences (PEs) may increase risk for mental disorders, non-suicidal self-injury (NSSI), and suicide attempts, relative to PEs that are more transient and remitting in nature. Most investigations of PE persistence have incorporated only two waves of data, and have not investigated the persistence of different PE subtypes and their association with future NSSI and suicide attempts. This study aimed to investigate the association between PE persistence, NSSI, and suicide attempts using three waves of prospective data. A secondary aim was to investigate potential reverse pathways where self-injurious behaviour (and its persistence) instead precedes subsequent PE occurrence. METHOD Participants were 1100 adolescents (12-17 years) from an Australian prospective cohort study; with three time points over two years. The Self-Harm Behaviour Questionnaire was used to assess NSSI and suicide attempts. Four PE subtypes (auditory hallucinatory experiences [HEs], and three delusional experiences) were assessed using the Diagnostic Interview Schedule for Children. Logistic regression analyses were conducted where PEs was grouped into five categories according to their persistence across the three waves of data. Analyses were adjusted for sociodemographics and substance use. RESULTS Overall, persistence of PEs (with endorsement of PE across two or three waves) was associated with the highest risk of incident NSSI and suicide attempts at 1- and 2-year follow-up (OR range: 2.57-12.25), whereas remitted PEs (with endorsement of PE at baseline only) were not associated with increased risk of future NSSI or suicide attempts. This pattern of association was evident for auditory HEs but not for most other PE subtypes; although some estimates had wide confidence intervals. There was no support for reverse temporality. CONCLUSION Our findings support and extend the two-wave cohort literature demonstrating that PEs which persist over time are more robust predictors of future NSSI and suicidal behaviour. Auditory HEs that are persisting in nature are an important but under-recognised risk factor for NSSI and suicide attempts during adolescence, and current findings should inform clinical guidelines into the predictors of self-harm and suicide risk at this life stage.
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10
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Mennigen E, Bearden CE. Psychosis Risk and Development: What Do We Know From Population-Based Studies? Biol Psychiatry 2020; 88:315-325. [PMID: 32061373 PMCID: PMC7305046 DOI: 10.1016/j.biopsych.2019.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022]
Abstract
Recent years have seen an advent in population-based studies in children, adolescents, and adults that examine the prevalence, etiology, and developmental trajectories of diverse subclinical psychopathological symptoms that pose a risk for the later development of severe mental illnesses. It is increasingly recognized that most categorically defined psychiatric disorders occur on a spectrum or continuum, show high heterogeneity and symptom overlap, and share genetic and environmental risk factors. We discuss neurodevelopmental underpinnings of psychosis spectrum symptoms and review brain morphometric and functional alterations as well as genetic liability for psychosis in individuals experiencing psychotic symptoms (PSs) in the general population. With regard to brain structure and function, findings of qualitatively similar alterations in individuals experiencing subthreshold PSs and individuals with overt psychotic disorders support the notion of a psychosis continuum. However, genetic and epidemiological studies have emphasized the overlap of PSs and other psychiatric illnesses. In particular, PSs during adolescence appear to be a nonspecific precursor of different psychopathological outcomes. Given the evidence presented in this review, we argue that findings from population-based studies are appropriate to guide policy-making to further emphasize public health efforts. Broadly accessible mental health programs are promising to make a difference in the field of adolescent mental health. However, the specific efficacy of these programs warrants further study, and caution is advised to not overpathologize potentially transient occurrence of mental health problems.
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Affiliation(s)
- Eva Mennigen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychology, University of California, Los Angeles, Los Angeles, California.
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